Mobilizing to Improve Healthcare Systems in Rural Areas

First Row, L-R: Asec Gerardo Bayugo, ZFF BOT Daniel Zuellig, ZFF President Ernesto Garilao, ZFF Chairman Roberto Romulo, ZFF BOT Reiner Gloor, ZFF BOT Kasigod Jamias, ZFF BOT David Zuellig, ZFF BOT Dr. Esperanza Cabral

Second Row, L-R:  Hinatuan Mayor Candelario Viola, Magsaysay Mayor Rommel Dela Torre, Cataingan Mayor Wilton Kho, Mandaon Mayor Kristine Salve Hao, Matuguinao Mayor Melissa Dela Cruz, Tinambac Mayor Ruel Velarde, Del Carmen Mayor Alfredo Coro II, San Fernando Mayor Eugenio Lagasca, Jr.

Weak health systems, poor health-seeking behavior, absence of adequate road infrastructure, and lack of transportation facilities prevent Filipinos living in rural communities from accessing quality healthcare services, according to eight municipality mayors from geographically isolated and disadvantaged areas (GIDA).

In a colloquium hosted by the Zuellig Family Foundation (ZFF) titled "Bridging Social and Health Inequities: The GIDA Experience," the mayors who also stand as their respective municipality's health leaders shared health challenges experienced by GIDA residents, as well as the reforms implemented to address those health gaps with the help of their local communities and ZFF.
Mandaon (Masbate), Del Carmen (Surigao del Norte), Hinatuan (Surigao del Sur), Tinambac (Camarines Sur), Cataingan (Masbate), Magsaysay (Palawan), Matuguinao (Samar), and San Fernando (Camarines Sur) are among the partner municipalities of ZFF in its "Community Health Partnership Program" (CHPP) -- a model of health intervention involving health leadership and governance training activities.

In a bid to promote sustainable and accessible healthcare system in the Philippines, especially in rural areas, ZFF established the two-year program focusing on technical skills to improve service delivery, access to medicines, information systems and health financing.

"While we recognize that the road to achieving better health outcomes in remote areas is difficult, we also know that health reforms must start now. ZFF, in partnership with mayors of GIDA, are taking up this challenge so that the poor can enjoy quality healthcare services, and no woman or infant dies because of childbirth complications," said Ernesto Garilao, Zuellig Family Foundation President.

GIDA municipalities, or those with marginalized population physically and socio-economically separated from the mainstream society, suffer from high maternal mortality rate -- often higher than the latest national average of 221 deaths per 100,000 births, as reported in 2012 by the Department of Health (DOH). This is a far cry from the country's Millennium Development Goals (MDG) of 54 by 2016.

Mayor of partner GIDA municipalities pointed to low facility-based deliveries (FBD) and low skilled birth attendants (SBA) as among the causes of high maternal deaths. In addition, they cited malnutrition and poor sanitation as alarming health problems in their areas.

With the help of ZFF, the mayors reported that a number of health reforms has been implemented, including the establishment of more birthing units and health centers to provide access to more residents in their areas, as well as the purchase of an ambulance in order to reach even the farthest barangays.

 Beyond the financial aid, the mayors highlighted CHPP's biggest achievement: educating and empowering them as health leaders, as well as other community leaders and local health officials to develop health reforms for those they serve.

“I learned about co-ownership during the training,” Mayor Alfredo Coro II of Del Carmen, Surigao del Norte, said. “That presented to me a realization that the dynamic health system is not a linear process, but should instead be treated with a set of realistic targets of governance that can be performed even at the smallest unit of the municipality to really achieve the health indicators.”

Del Carmen's programs included awarding the "Seal of Health Governance," to encourage barangays in meeting specific health requirements, which have the equivalent “seal” of bronze, silver, and gold as well as financial grant. This program, as well as other barangay health system reforms, resulted to better health outcomes: from 76 percent of both SBA and FBD in 2011, the municipality now stands at 95 percent and 94 percent, respectively.

Meanwhile, Mayor Ruel Velarde of Tinambac, Camarines Sur cited the need for willingness from the community in overcoming health challenges. “Community development is a shared responsibility among political leaders, health advocates and constituents. It is about reaching out to each other, building strength, and supporting people to reach their goals," he said.

To address the poor health-seeking behavior of parents, the mayor sought the help of local parish priests in conducting seminars on responsible parenthood and family planning -- a partnership that is the first of its kind in Camarines Sur. Participants included pregnant mothers, newly engaged couples, parents, barangay officials, health workers, LGU employees, and police personnel. As of this year, there has been no maternal death in the municipality.

Recognizing the limited resources and capacity of the municipality to address all health issues, Mayor Melissa Dela Cruz of Matuguinao,Western Samar forged  partnerships with external stakeholders to help establish their health care system.

With ZFF and the Armed Forces of the Philippines, they launched the Health Education Advocacy Program (HEAR) wherein health education sessions are regularly aired through the AFP’s community radio station. Other partnerships were also sought for the completion of the Gandara-Matuguinao Road and the installment of “Wireless Access for Health” to enable midwives to electronic data. Results of these initiatives have been positive -- zero maternal deaths so far in 2014 and marked improvement in skilled birth attendants and facility based deliveries.

In sharing these and other health reforms during the colloquium, ZFF hopes that the government, non-government organizations and the academe will be able to identify replicable strategies to help achieve the country's MDG health targets. "We also hope other private institutions support in strengthening health reforms at the barangay level and in capacitating communities to manage self-sufficient systems to achieve better health outcomes," Garilao said.

DOH Secretary Enrique Ona was present during the colloquium, as well as representatives from Philhealth, DOH Regional Directors, the academe, the multilateral agencies — UNFPA, UNICEF, MSD — and NGOs — Ayala Foundation, Jollibee Foundation, Andres Soriano Foundation, and CARD-MRI.